Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain

Abstract

Objective: The purpose of this study was to investigate the outcomes of adding lumbar sustained natural apophyseal glide (SNAG) to a conventional therapy program for chronic nonspecific low back pain (LBP). Methods: Forty-two participants with chronic nonspecific LBP were randomly divided into 2 groups. The study group (aged 27.1 ± 8.3, 20 men, 3 women) received a conventional physical therapy program consisted of stretching and strengthening exercises plus SNAG (based on the Mulligan concept) on the affected lumbar levels, and the control group (aged 28.9 ± 7.7, 13 men, 6 women) received the same conventional program without SNAG 3 times per week for 1 month. Outcome measures were repositioning error (the primary outcome), pain, and function measured by an isokinetic dynamometer, visual analog scale, and the Oswestry Disability Index. Measurements were recorded before and after the end of the treatment period. Results: The comparison between pretreatment and posttreatment test scores indicated that both study and control groups had significant improvement in all dependent variables (P N .001). However, adding SNAG to the conventional program resulted in higher improvement in terms of repositioning error, pain, and function (P = .02, .002, .008) respectively. Conclusions: This preliminary study indicated improvement in both groups. Adding SNAG to conventional programs in the treatment of chronic nonspecific LBP may result in greater improvement of repositioning error, pain reduction, and improved function. (J Chiropr Med 2017;16:94-102)

Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial

“…In contrast, the exclusion criteria were as follows: pregnancy, obesity, contraindication for physical and manual therapy, history of fractures, tumors, lumbar stenosis, neuropathy, radiculopathy, rheumatoid arthritis, lumbar spine surgery, and long-term use of steroids. These factors were considered as exclusion criteria because these factors were associated with the exacerbation of symptoms or serious damage [20]. The study protocol was approved by the Sahmyook University Institutional Review Board (2-7001793-AB-N-012019002HR), and it was registered (KCT0005094) on Clinical Research Information Service (CRIS) in the Republic of Korea.…”

“…First, the symptomatic spinal level was determined by performing standardized clinical examinations. Subjects were asked to perform active trunk flexion and extension to identify which motion induced greater pain and the most painful vertebral level by applying passive accessory intervertebral movement [20]. Second, subjects were seated on a height-adjustable table while both feet were placed on a footrest slightly plantar flexed.…”

“…Because of the capsular strain correction of the lumbar facet joint, MMST improved. Stability, pain, and proprioception are affected by the lumbar facet joints [20]. Therefore, applying SNAGs to mobilize the affected facet joints may release capsular strains, resulting in ROM improvement [41].…”

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

“…e glide occurs in the articular plane, and the movement is performed in loading [99]. e reports indicate that the addition of the SNAG technique to other rehabilitation methods improves the range of spinal mobility and reduces pain [100][101][102]. e literature also indicates that compared to incorrect mobilization, the SNAG technique did not bring better results in terms of mobility [99].…”

Smartphone usage duration is not associated with increased pain or proprioception deficit in young adults with chronic mechanical low back pain: a cross-sectional study

“…To measure repositioning acuity, for each participant, the assessor determined the available back range of motion (ROM) starting from the 0°position (erect neutral sitting with hips flexed 90°) to maximum flexion. Proprioception was then tested between zero neutral position to 30°of flexion [22,25].…”